Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen.
All patient vignettes are confabulated; the psychiatrists, however, are mostly real.
--Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask. (It's not Shrink Wrap.)

Thursday, August 03, 2006

A few days ago, Dr. Crippen (NHS Blog) wrote a moving piece called Removing Death from Life. He takes a look at dying, the hospice system, the what we've come to expect from death:

There is a danger that the hospice movement will steal death from life. Death should take place in the home. With the family. If there is no family, the hospices are wonderful. If the family cannot manage, for whatever reason, the hospices are wonderful. But they are not compulsory, nor are they a “better” option. They are a failsafe.The second, and more serious problem, is that the hospice movement and the media have conspired together to present death and dying as something that is really rather wonderful. A clap-happy learning experience to be shared and enjoyed with all the family. The gullible like to invest in this.

As a society, we've come to believe that people don't need to suffer. If you're in pain, something's wrong, go to the doctor, it can be fixed. In many ways, this is a good thing, fewer people suffer needlessly with mental illnesses because of the awareness that some suffering is the result of a treatable disease: they come for help and they get it (this is good). Others are diagnosed with illnesses that, had they waited, would have been fatal (say early stage cancers, infections that might spread, and the list marches on). This is also good. Life, however, remains chock full of suffering, and not all of it is about treatable illnesses, and Death is no exception. Family members suffer when their loved ones die miserable deaths, only now they are left to believe they should have done something "more" to help the loved one die differently.

As Dr. Crippen so bluntly puts it:

Dying is unpleasant. With optimum symptom control it need not be painful, or not for long, but it is uncomfortable, it is distressing and it can be undignified. Much can be done, and much should be done, but let us not try to spin dying into something it is not. It is, I repeat, an unpleasant business.

8
comments:

excellent post. I think this is something that workers in all aspects of medicine need to pay better attention to.

I can't help but think that for all our medical sophistication, we're getting lost in treating symptoms instead of diseases. Even making symptoms out to be the disease, and thus doing our (well, soon to be our) patients a great disservice

I am always reminded of how Timothy Leary, who was dying of prostate cancer, declared that he was going to "transform" death. In the end, it was just death. No better, no worse than anyone else.

Eight years ago I was recovering from surgery for colon cancer at a relatively young age (there is a significant genetic proponderence in my family), and I was divided by a curtain from the man next to me. I surmised from what I heard that he was elderly and dying. I never saw him, and we never exchanged a word. On a late afternoon, I heard his daughter arrive, and all I recall was her telling him, "If you want to go, it's OK. We'll be OK." By coincidence or otherwise, he died in the middle of the night, and was removed from the room. I remember thinking why did they bring him here to die, alone and in the middle of the night? Undoubtedly there is more to the story than I am aware. But it is something I will not forget.

Birth, copulation, and death. That's all of the facts when you're down to brass tacks. Birth, copulation and death.

So I liked Dr. Crippen's post not so much because it blasted hospice (I've not heard anything bad about Hospice care, mostly good things, and I'm not sure it's even the same experience here as in the UK). Mostly I quoted and borrowed the piece because it resounds of a theme we've been talking about here-- expectations, suffering, what is illness versus human variation, and extending the expectation of happiness during death-- or the expectation that the Death Experience would fit into some little box of an event-- seemed to extend the discussion.

I just wanted to comment to Carrie that I find it a little distateful for outside observers to analyze, dissect, and then judge or rank individual death experiences as to which was better (or less bad) than the other and which was apparently more correct or proper than the other.

As for SSRIs, they are necessary sometimes to dull (mental) pain. But you're right, they're simply feeling-dullers. They change a person into someone they're not, no matter how much M.D.'s would like to say that they target specific symptoms. Inhibitions - dulled. Unpleasant feelings - dulled. Pleasant feelings - dulled. Motivation and caring - dulled (as in the ability to read horrible articles in the paper and blithely dismiss them as, "Oh well, not my problem. Time to move on with my day and go get something big and fattening to eat - who gives a rip about calories, anyway?"